Transcript Slide 1

Establishing a
Foundation for Medicaid’s Role
in the Adoption of HIT
Jay Himmelstein MD, MPH
Michael Tutty MHA, Shaun Alfreds MBA, CPHIT
UMass Center for Health Policy and Research
November 8, 2005
Medicaid, HIT, and the “Safety Net”
•
In 2004, the UMASS Center for Health Policy and Research (CHPR) was
asked by the Massachusetts’ Executive Office of Health and Human Services
(EOHHS) to help develop a plan for enhancing the capability of essential
community providers (ECPs) to improve access, reduce care variation, and
improve the quality of care delivered to Medicaid (MassHealth) members
– Community Health Centers are key ECPs in Massachusetts
•
CHCs serve as primary care providers for over 150,000 Medicaid managed
care members (28% of total)
•
Recommendations were based upon a series of discussion forums and
interviews with key stakeholders in the Massachusetts health care community
•
A major recommendation was to support the adoption of health care
information technology, namely electronic health records
How does a State and it’s Medicaid program support the adoption of
HIT/EHRs in the provider community, particularly for those providers
serving Medicaid, underinsured, and uninsured populations?
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Benefits and Challenges
of HIT adoption for Medicaid Agencies
Benefits of HIT Adoption
• Improved tracking and care
coordination for Medicaid
members and uninsured among
healthcare providers
• Support for the integration of
physical, behavioral health, and
other specialty services
• Prevent duplication of care and
tests
• Improved quality of care
through the use of tools such as
evidence-based practice
guidelines and e-prescribing
• Improved efficiency/lower cost
of care provided?
Challenges to HIT Adoption
• $$$$$$$$$$$$$$$
• Where does the $ come from?
• What mechanism?
• Medicaid, state laws, HIPAA, or
other regulations that act as
barriers to information sharing,
interoperability, security,
authentication and penalties for
non-compliance
• Complex data standards
• Interoperability with Medicaid IT
systems
• Intricacies of Medicaid health
reform
• Special needs of ECPs
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Estimated Use of Health Information
Technology in Massachusetts
Provider Type
Total Hospitals
Group Practice/Solo Physicians
Community Health Centers
Total Patient Care Office Based
(16,256 physicians)
State
Providers
Estimated Use of EHR
115
19%
~7,390
10-35%
51
44%
~7,441
10-44%
Medicaid involvement must take into account the needs of the provider
community. How many providers are there? What level of HIT adoption
are they at?
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Estimated Costs and Benefits of EHR
Implementation in MA
Total 1st Year
Cumulative 5 Year
Estimated Ambulatory EHR Costs
($802.1 M)
($1,241.2 M)
Estimated Interoperability Interface Costs
($220.1 M)
($220.1 M)
($1,022.2 M)
($1,461.3 M)
Total 1st Year
Cumulative 5 Year
Hospitals
$21.2 M
$505.2 M
CHCs/Groups/Independent Physicians
$7.3 M
$174.6 M
Payers/Purchasers
$76.5 M
$1,820.6 M
$105.0 M
$2,500.5 M
($917.2 M)
$1039.2 M
Estimated Costs
Total EHR and Interoperability Interface Costs
Estimated Savings (Benefits)
EHR and Interoperability Savings
Estimated Net Benefit of EHR and
Interoperability
Costs and benefits are not equally distributed. Medicaid involvement
needs to be viewed through realistic time frames based on current HIT
adoption and likely rates of adoption.
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Estimated Percentage Diffusion of Ambulatory
EHR to all MA Providers
• Most cost and benefit analyses assume a 1time investment to connect 100% of
providers, this does not accurately represent
the diffusion of new technologies.
• CHPR, based on the work by RAND, applied
diffusion curves to the MA specific
cost/benefit assumptions
100%
Percentage Diffusion (Adoption)
90%
80%
70%
EHR is expected to
diffuse to ~87% of
providers
60%
50%
2007 - 43.2% with $50M infusion
40%
2007 - 32.5% with no intervention
30%
20%
10%
First EMR in MA
~1982/1983 with
rudimentary intraoperability
0%
1983
1987
1991
2004 - 18.8% Adoption
1995
1999
2003
2007
2011
2015
2019
2023
2027
Year
No Policy Intervention
3-year $50M Infusion in 2005
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Estimated Ambulatory EHR Diffusion in MA
Diffusion and Failure
Percentage Diffusion (Adoption)
100%
• According to some
researchers there has been a
30-40% failure rate of EHR
implementations
• These failures are a result of:
–Lack of implementation
planning
–Inadequate research and
expectations of technology
–Incomplete training of staff
–Mismanagement of
workflow and staffing
changes
–Reluctance of providers to
take on additional burden
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2004
2006
2008
2010
2012
2014
Expected
2016 2018 2020 2022 2024 2026
Year
3-yr $50M Infusion 30% Failure Rate
2028
2030
Including a 30% failure rate reduces adoption rates significantly, increasing the time
required to reach 80% adoption from 10 years to 18 years. Any investments made by
public entities need to ensure the appropriate level of support in the planning, research,
purchasing, implementation, and sustainability of all HIT systems.
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State Data Sharing Example
MedsInfo-ED
The Initiative
State Involvement
Description
A patient safety initiative to automate the
transmission and communication of
medication history to emergency
departments. The project is a "proof of
concept" designed to demonstrate the
value of making patient medication history
accessible to clinicians at the time of
treatment
The State has been an important
participating data source for medication
history to the project
• Public employees Group Insurance
Commission (GIC) and MassHealth
interface and connection completed
pilot project in Fall 2004
• Technologically not difficult
• Navigating the laws and regulations,
including specific rules on Medicaid, is
challenging
• Participation from various staff
• Program staff
• IT
• Legal
Source: Mass Health Data Consortium and various interviews with MassHealth staff
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State Data Sharing Example
MedsInfo-ED
State Involvement
Note: Neighborhood Health Plan is one of the Medicaid HMOs.
Source: Mass Health Data Consortium/MA-Share
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State Data Sharing Example
MedsInfo-ED
The Opportunities
• More streamlined & efficient process to
obtain medication history
• More complete & accurate medication
history
• More complete & accurate medication
orders for patients admitted
• Decreased “errors” in diagnosis and
treatment
• Improved outcomes and lowered costs
of care
Better outcomes and efficiency should
be good for patients and State payers
The Challenges
Technology was not a major challenge
Gaining consensus/understanding of the
various state and federal privacy and
security standards and requirements
• Pilot project had to screen-out “sensitive”
classes of medications for treatment of
HIV/AIDs, mental health, substance abuse for
MA law compliance
• Fair Information Practices Act governs data
held by MassHealth and GIC
• Medicaid has additional regulations that must
be considered
Limited use of tool
•
•
•
•
Not all payers involved (e.g. Medicare)
Need for medication knowledge varies
Filtered-out restricted drugs
Inactive/terminated members not available
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Where do State Medicaid Programs Fit?
Patients
HIE Portal
Clinical Data
Repository
Results
e-Prescribing
EHR
Health Ctr. Hospital Pharmacy
Physicians
Billing & Scheduling
Ref. Labs Groups
Incentives for Adoption
(P4P, grants, tech assistance, regulations, other?)
Other
Payers
Medicaid
Medicaid
MCOs
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What We’ve Learned So Far
•
Significant opportunities exist for Medicaid to enhance HIT infrastructure to support
evidence based practice, care coordination, quality improvement, and
cost/operational efficiencies
– Medicaid, as the largest payer for safety net providers, has an important role and
stake in supporting HIT adoption by CHCs and the ‘safety net’.
•
To take advantage of these opportunities State Medicaid agencies need to
understand the complexities and opportunities related to HIT adoption, utilization, and
interoperability, including:
– Targeted financial and non-financial incentives for HIT adoption
• Potentially unique opportunities for financing IT implementation for CHCs
– Consideration of unique legal constraints of Medicaid when appropriate
– Participating in standard setting:
• Address the unique needs of their members, providers and communities
• Alignment of standards from Feds (CMS, HRSA), states, and commercial
payers
– Leveraging clinical data from HIT to achieve operational efficiencies within
Medicaid: e.g. prior approval processes for drugs and devices, quality monitoring
and improvement
• Participation in HI collaboratives which include both public and private
systems
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Current Project: Establishing a Foundation for
Medicaid’s Role in the Adoption of HIT
•
CHPR is working in collaboration with AHRQ and NRC to define the
challenges and opportunities that Medicaid programs face in relation to the
adoption of clinical HIT
– Define the range of roles that state agencies might play in leveraging HIT
developments to improve the quality and efficiency of care received by Medicaid
members
– Identify current Medicaid best practices and policies relating to HIT
•
The deliverables will identify knowledge gaps, lessons learned, and key
prioritization areas for federal and state policy makers as Medicaid agencies
participate in the development of state and regional health information
networks
– Develop series of relevant policy papers in collaboration with key thought leaders.
– Arrange for and facilitate an expert meeting of HIT experts and policy makers at
the state and federal level
This information will provide the foundation for assisting Medicaid
agencies in planning and supporting HIT dissemination and its use in order
to increase the quality of health care
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For Further Information
Jay Himmelstein MD, MPH
Director UMass Center for Health Policy and Research
E-mail: [email protected]
Michael Tutty MHA
Senior Project Director
E-mail: [email protected]
Shaun Alfreds MBA, CPHIT
Project Director
E-mail: [email protected]
University of Massachusetts Medical School
222 Maple Avenue Shrewsbury, MA 01545
Phone: 508-856-7857
Fax: 508-856-4456
Web: http://www.umassmed.edu/healthpolicy/
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